1629 Sheffield Rd t_-�_' '^ `^ .- { -` - '.ei-. • i'� i f.;r r rf'�-_ �• r^+/e Y' . "e'} ' r • r i i{.:.i<;f,. ..���. :'ii- . , :i4.
Y DAVIE COUNTY HEALTH DEPARTMENT J. 6.T}
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION p 0
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage System PermitcNumbber
Name 1� �s. J �r�1. _°� �s d Date - � I - �D- N0 V 9.4 8
Location �
sla Q�
Subdivision Name Lot No. Sec. or Block No.
Lot Size 1� �` �' House Mobile Home —T Business -- Speculation
No. Bedrooms No. Baths No. in Family —
Garbage Disposal YES ❑ NO B- Specifications for System:
Auto Dish Washer YES B' NO ❑
Auto Wash Ma,.hine YES it NO ❑
Type Water Supply __—
*This permit Void if sewage system described below is not installed'within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
-J T r
�. "
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system,between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by _�
Certificate of Completion `� - �� Date 1 Z
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
ff WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME 1` o �' h1z �a PHONE NUMBER y 411,0
ADDRESS �S� gSUBDIVISION NAME
// SUBDIVISION LOT#
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN BY